距骨骨折手术入路---前外侧入路

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1、Indications适应症：Theanterolateralapproachisusuallyemployedincombinationwiththeanteromedialapproachtogainaccesstoanydisplacedtalarneckfracture.前外侧切口通常于前内侧切口联合应用以充分显露距骨颈。However,forcertainfracturessuchasminimallydisplacedfracturesorverysimpleneckfractures,itcanbeusedasthesoleapproach.然而，当骨折明确如无

2、明显移位骨折或简单距骨颈骨折，也可以单独使用前外侧入路。       Anatomy     解剖Aroundtheankleandhindfoot,full-thicknessincisionswithoutunderminingareimperative.Toavoidcuttingthebranchesofthesuperficialperonealnerve,mostoftheincisionsmustbemadeinalongitudinaldirection.在踝关节和后足，必须用全厚层皮瓣切口。为避免切断腓浅神经，切口需要设计纵轴方向。Thesuperficia

3、lperonealnerveliesintheincisionorverynearandmustbeavoidedandprotected. 腓浅神经多位于手术切口附件，必须注意保护。          Incision     切口Skinincision         皮肤切口Theincisionsherearebasedonthedeeptalaranatomywhichliesunderneaththeextensordigitorumbrevis. Theincisionisbasedonthefourthmetatarsalandlinesupwiththis

4、bone.切口与其下的解剖相关，伸趾短肌位于下方，与第4跖骨平行。        Deepdissection    深层分离Themuscleofextensordigitorumbrevisisbulkybutoncethismuscleissplit, onegainsaccesstothelateraltalusandsubtalarjoint.伸趾短肌体积明显，但是，一旦分离此肌肉，距骨外侧和距下关节就看到距骨前外侧和距下关节了        Exposureoftheanterolateraltalarneck显露前外侧距骨颈Oncetheextensordigi

5、torumbrevisissplitlongitudinallyandretracted,oneexposesthelateralaspectofthetalarneck。当伸趾短肌被牵开，距骨颈就显露出来了。Mosttalarneckfracturesresultfromamediallydirectedforce.Therefore,thelateralsideoftheneckcomesundertensionandthemedialsideundercompression.Thefracturesonthelateralsidearesimple,andontheme

6、dialsidemultifragmentary.Exposurefromthemedialsidealonerunstheriskofshorteningtheneckandmalreducingthefracture.Toensureananatomicreduction,fracturesoftheneckmustbeexposedfromthelateralandmedialside.多数距骨颈骨折是由于内侧直接暴力引起。因此，距骨颈外侧面承受张力，而内侧面承受压力。所有，外侧面骨折多是简单骨折，内侧面骨折多粉碎骨折。单纯显露内侧面有引起距骨颈短缩，和引起骨折复位不良

7、。为了达到解剖复位，颈部骨折必须暴露外侧和内侧面。 Thearrowontheimageindicatesasimplefractureofthetalarneck.下图的箭头显示距骨颈简单骨折     Debridementofsubtalarjoint     复位距下关节Debridementofthesubtalarjointisimperativetofacilitateanexcellentreduction.距下关节必须得到很好的复位。Usingbothanterolateralandan